A new study published July 7 in Health Affairs found that poor, uninsured patients who enrolled in a Medicaid-like insurance plan had better care and health outcomes than those who remained uninsured -- all achieved with total costs of enrollees' care that were 28.7 percent below the spending cap allowed by the federal government. The study examined the impact of MetroHealth Care Plus, which extended Medicaid coverage to 28,295 Cuyahoga County residents before the expansion of Medicaid took place in Ohio. "The results challenge recent reports and contribute to the ongoing debates on the value of expanding health care coverage to more poor Americans," said Randall Cebul, MD, President and CEO of Better Health Partnership and lead author of the study.Read the news release.

News report notes improvement of 60,000 Northeast Ohioans with diabetes and high blood pressure; work to eliminate disparities in care and outcomes.Click here for more

February 7, 2015

Lake Health initiating new patient care model

A new partnership between local employers and Lake Health is hoped to improve the
services and ultimately the health of thousands of area individuals. The initiative is a pilot
collaboration with the Lubrizol Corp., Lake County Schools Council, the Progressive Group
of Insurance Companies and Lake Health to provide coordinated, patient-centered care for
employees who receive care from a physician in the Lake Health Integrated Physician
Hospital Enterprise. Read more.

February 1, 2015

Lake Health partnering with major employers

Population health and accountable care are hot topics in the rapidly evolving health care industry, but
Lake Health — one of the few independent hospital systems left in Northeast Ohio — believes it's
taking those concepts to the next level with an experimental project involving three of the region's
major self-insured employers.

Lubrizol Corp., Progressive Corp. and the Lake County Schools Council have teamed up with the health
system to provide coordinated, patient-centered care for employees who receive care from one of 300
of Lake Health's primary care and specialty physicians. Also, as part of the arrangement, the
employers are paying a monthly fee per member to Lake Health to manage their employees'
care. Read more.

A landmark step in health care transformation – payment reform – is here, paving the way
for a major shift in how insurance companies pay health care providers in the near
future. Greg Moody, Director of the Governor’s Office of Health Transformation, will
address The City Club on Tuesday, January 27, at 12:00 PM to present Ohio’s plan for
change. Mr. Moody also will speak earlier at Better Health Greater Cleveland’s meeting to
present its 14th report on the quality of health care in the region, also at The City Club.
The Office of Health Transformation is resetting the rules so the incentive is to keep people
as healthy as possible, pay for what works to improve and maintain health, and shift from
fee-for-service payments to population- and value-based payments that reward patient-
centered care coordination and better health outcomes. Read the full news.

August 5, 2014

Hospital Reboots Medicaid To Give Better Care For Less Money

MetroHealth's Medicaid waiver program delivered better care, better outcomes and better
costs with population management approaches and care coordination. "All of the clinical
outcomes are really amazing," said Randall D. Cebul, MD, in a 90.3 WCPN story featured on
NPR August 5. Read or listen.

Sept. 30, 2013

Be Well: Choose Wisely

Amidst all the debate about healthcare in America are a couple of undeniable facts: We
spend at least twice as much per capita as almost any other country; and countries that
spend a lot less often have better health outcomes. One of the latest national efforts to
address costs and benefits of medical treatments comes to Cleveland later this week. Read
more or listen.

Sept. 25, 2013

Beyond Camden: In Ohio, Will Providing More Care to High Utilizers Save Money?

If a health system delivers more
services to patients with chronic
conditions, will it lose money or
save money? To answer this
question, the MetroHealth Medical
Center, in Cleveland, is conducting a
study of what it calls the Red Carpet
Program. As the name suggests,
MetroHealth is figuratively rolling
out a red carpet for 150 patients
with diabetes, hypertension, and
heart failure and provide more care
to these patients for 18 months.
Then it will compare the before and after costs. Read
more.

March 11, 2013

Internists should pursue innovative practice models

The patient-centered medical home and the accountable care organization allow internists
to do a better job caring for patients, and there is at least some early evidence that they
may reduce the costs of care.

David Bronson, current president of the American College of Physicians, writes about
Better Health Greater Cleveland. Read
more.

February 18, 2013

AMA details plan for cutting hospital readmissions

Outpatient physician practices can play a key part in ensuring that patients have safe
transitions in care and avoid preventable hospital readmissions, according to an American
Medical Association report released in February. Read
article.

CLEVELAND – Better Health, a regional health improvement collaborative in northeast Ohio
reported that hosptializations for cardiovascular conditions addressed by its programs fell
by 10.7 percent in 2011, building on declines in 2009 and 2010. According to Better Health
this is first time a decline in avoidable hospitalizations has been reported as a result of a
regional health collaborative’s efforts. Read
article.

December 18, 2012

Rolling Out the Red Carpet for ED "Super-Utilizers"? Taking a Patient-Centered Approach

"Super-utilizers" -- people who go to the emergency department frequently and often
unnecessarily -- are often looked down upon, as they constitute a small percent of overall
ED patients but account for the majority of costs. Some healthcare providers and the
population at large perceive these "super-utlilizers" as nuisances -- people who make the
ED crowded and contribute to long wait times and high costs. However, some healthcare
organizations are taking a more patient-centered approach...

Click here to read more about Better Health Greater Cleveland's Red Carpet Care program,
funded by Robert Wood Johnson Foundation, that is underway at MetroHealth and two
of its health plan partners, Medical Mutual of Ohio and Buckeye.

Regional Healthcare Improvement Collaboratives Needed Now More Than Ever:
Program Directors' Perspectives

"If a national vision of value-driven, patient-centered care is to become a reality—one that
results in better care, better health of populations, and lower costs—Regional Healthcare
Improvement Collaboratives, such as those embodied by the RWJF’s AF4Q initiative, are a
necessary part of the solution. Each collaborative represents a neutral common table for all
stakeholders to discuss their unique concerns while recognizing their shared.
Read the article.

August 29, 2012

Local Solutions Spark Readmission Reductions

With the Oct. 1 start of penalties for excessive readmissions looming,
Hospital published a cover story featuring innovation solutions to reducing readmissions --
and featured Better Health Greater Cleveland, Aligning Forces for Quality, and William C.
Cook, DO, a Kaiser Permanente hospitalist who co-chairs Better Health's Steering
Committee for care transitions.

"From the hospitalist perspective, our role is to make care transitions safe and predictable,"
Dr. Cook told the magazine. "The way I can contribute most to these transitions is by
thinking ahead about what's going to happen next—and how do I prepare the patient and
the next provider." Read the article.

December 11, 2011

Greater Cleveland should grab the chance to shift to medical homes: editorial

What if health insurers, employers and health care providers banded together to help
consumers buy smarter medicine? Don't rule it out. The idea -- the "patient-centered
medical homes" model of care -- is beginning to take hold. The next step is to get it off the
drawing board and into examining rooms, human resource departments and benefits
managers' offices in a much bigger way. In Northeast Ohio, a group called Better
Health Greater Cleveland has been at the task for several years now, advocating among the
various stakeholders in both medical care and payment for a shift to medical homes
supported by electronic health records. Read more.

September 6, 2011

EHRs Beat Paper in Head-to-Head Competition

Electronic health records (EHRs) show promise to improve quality of care and patient
outcomes—that’s why the federal government is investing billions of dollars in them.
he more than 500 primary care physicians in 46 practices who took part in the study are all
members of Better Health Greater Cleveland, a nonprofit healthcare alliance made up of
providers, health plans, employers, and government agencies focused on improving the
health of chronic disease patients in Northeast Ohio. Read more.

September 6, 2011

The Cleveland Experiment

There have been a number of research studies published that question the value of
Electronic Health Records (EHRs), particularly as it pertains to improving quality of care and
ultimately outcomes. Chilmark has always viewed these reports with a certain amount of
skepticism. Simple logic leads us to conclude that a properly installed (including attention
to workflow and thorough training) of an enterprise software system such as an EHR will
lead to a certain level of standardization in overall process flow, contribute to efficiencies
and quality in care delivery and ultimately lead to better outcomes. But to date, there has
been a dearth of evidence to support this logic, that is until this week.
Read more.

September 6, 2011

Tech That Powers Quality Standards

A study published in the New England Journal of Medicine is among the first to put hard
numbers on the benefits of electronic health records. Researchers looked at four national
quality standards, including: 1) Eye exams, 2) pneumonia vaccinations, 3) outcome
measures such as blood sugar, blood pressure, and cholesterol control, and 4) patient-
driven issues such as obesity and smoking.
Nearly 51% of patients in EHR practices received care that met all four quality standards,
compared to just 7% of patients at paper-based practices. Nearly 44% of patients in EHR
practices met at least four of five outcome standards, compared to about 16% of patients
at paper-based practices.

The study is among the first to put hard numbers on the benefits of electronic health
records. But as the study's lead author, Randall Cebul, MD, said in an interview this week,
"51% is 49% short of ideal."

So what are the next steps? And how can health information technology get us there?
Read more.

September 1, 2011

New England Journal of Medicine Study Shows Benefits of EHRs Office of the National Coordinator's Buzz Blog

Yesterday the New England Journal of Medicine (NEJM) published a study, which looks at
care delivered to diabetic patients in physician practices that use electronic health records
compared to physician practices that do not. The results should not come as a surprise to
those of us who are working to speed the adoption and meaningful use of health IT:
Practices that use EHRs -- especially in conjunction with collaborative efforts to improve
quality -- delivered measurably better care than practices which rely on paper records.
Read more.

Distinguishing itself from previous efforts to prove the viability of EHRs and meaningful
use, a study published Wednesday in the New England Journal of Medicine shed light on just
what can be accomplished by using electronic medical records rather than paper records.
The finding: A survey of 27,000 adult diabetics spanning 500 primary care physicians across
46 practices in the Cleveland area found that those practices employing EHRs earned
“annual improvements in healthcare that were 10 percent greater than their paper-based
counterparts,” and their patients were “significantly more likely to have healthcare and
outcomes that align with accepted standards than those where doctors rely on paper
records.” Read more.

Researchers from Case Western Reserve University, Cleveland, report that provider
practices using electronic health-record systems had higher rates of compliance with
clinical quality improvement measures for diabetic patients than did their clinical
counterparts using paper-based record systems.

The research work was conducted in the Cleveland area, one of 16 communities the Robert
Wood Johnson Foundation selected to receive funding for the foundation's Aligning Forces
for Quality program. Through the program, office-based physician practices report on
quality-of-care and outcomes measures for patients who have chronic medical conditions.
Some of the participating Cleveland practices use paper-based recordkeeping systems;
other use EHRs. All were members of the Better Health Greater Cleveland, a RWJR-funded
collaborative for practice improvement.
Read more.

August 31, 2011

Study: E-Records Keep Patients Healthier

Electronic health records can help doctors give their patients the best care, at least when it
comes to diabetes, U.S. researchers reported on Wednesday.

The findings are a boost to the Obama administration’s electronic health-records program,
which offers doctors and hospitals financial incentives if they set up electronic health
records. The program will start penalizing providers in 2015 by cutting Medicare
reimbursement by 1 percent if they don’t use an electronic medical record.

Randall Cebul, a professor of medicine at Case Western Reserve University, and colleagues
found that more than half of diabetes patients got the best care as measured by four
standards if their providers used electronic health records. This compares to just 7 percent
of patients whose providers used old-fashioned paper, they reported in this week’s New
England Journal of Medicine. Read more.

August 31, 2011

EHR Incentives Likely to Improve Quality

Healthcare is one of the last industries in the United States to universally incorporate
technological advancements. While most sectors have made significant investments in
information technology to improve efficiency and consumer relationships, America’s health
care system is still largely paper-driven. As a result the healthcare system is plagued by
inefficiency and poor quality. Delivery is slower, more prone to errors, and harder to
measure and coordinate than it should be. Investments in health information technology
can help improve this situation. Research published in the New England Journal of Medicine (FREE FULL TEXT) gives cause for optimism that efforts to increase adoption of
electronic health records (EHRs) will provide major benefits in better patient care and
health outcomes. Perhaps we can finally move away from using a dead tree medical recod
system in this country.

To start with take a look at this video from a 1961 study that concluded that one day it is
going to be possible to relieve the nurses and doctors of some of their paperwork, and it is
going to be possible to have correlation of diseases which we have not had before, it is
going to be possible to eliminate errors in medications and tests which would have been
harmful to the patient:

“We were not surprised by these results,” said Randall D. Cebul, M.D., a professor of
medicine at Case Western Reserve University and the study’s lead author who I was able to
speak with earlier today. “They were influenced by several factors, including our public
reporting on agreed-upon standards of care and the willingness of our clinical partners to
share their EHR-based best practices while simultaneously competing on their execution.”

April 4, 2011

Enact social policies to improve Clevelanders' health

On Wednesday, Plain Dealer Reporter Ellen Kleinermen reported on the release of the
Robert Wood Johnson Foundation's "county health rankings." These indicators shine a
light on the multiple dimensions of our lives that influence our health, such as access to
healthy foods, education, income, teen pregnancy rates, smoking rates and quality of
health care.

Overall, Cuyahoga County ranked 69th of Ohio's 88 counties. Simply put, place matters --
where you live influences your health, wealth and life expectancy. State and local policies
can help to make Greater Cleveland a healthier place to live while simultaneously reducing
the costs of health care.

Promoting the availability of fresh fruits and vegetables in corner stores and creating safe
opportunities for physical activity in neighborhoods can make a difference. Our statewide
smoke-free law, community programs and the Tobacco Quit Line have reduced smoking
rates and saved lives and money. Increasing Ohio's cigarette taxes would generate
additional revenue for the state, reduce smoking rates and enjoy the support of a majority
of Ohioans. Adopting a penny-per-ounce tax on sugar-sweetened beverages would
significantly reduce obesity rates and generate almost half a billion dollars for Ohio's
General Revenue Fund.

Although Cuyahoga County ranked third in care quality, it's very low rankings on "social
determinants of health" must be addressed by actions outside the doctors' office.
Prevention is the best buy, and we are all stakeholders in a healthier community.

Terry Allan and Diane Solov, Cleveland

Allan is the health commissioner of the Cuyahoga County Board of Health.
Solov is the program
manager for Better Health Greater Cleveland.

March 31, 2011

Universal adoption of electronic health records will pay dividends

One year ago this weekend, Congress passed far-reaching legislation to overhaul the U.S.
health care system. Regardless of your personal views about the law, there are provisions
in it about which most people, as patients, should agree. These provisions provide
incentives for your doctor and her colleagues to adopt and use electronic health records
(EHRs) in a meaningful way. The incentives encourage your doctor to use EHRs to improve
the quality of your care and to increase communication with you and with other doctors
who share responsibility -- with you -- for your health. The goal is that "meaningful use" of
EHRs will help to improve health and blunt increases in health care costs.
Cuyahoga County is ground zero for much of this work. Physicians and hospitals in our
region have jumped into EHR adoption with both feet. The region is a leader of EHR
adoption nationally, and lessons we are learning are improving care in our community and
helping to guide the rest of the country. Read full article.

Greater Cleveland diabetes patients are showing health improvements in areas such as
blood sugar control, but the gains are threatened by a growing number of people losing
insurance coverage. A nonprofit collaborative called Better Health Greater Cleveland began
examining medical records of more than 25,000 diabetes patients in 2007. The program is
the first large-scale effort locally to report on how patients and their doctors are managing
the chronic disease.
Read full story.

June 15, 2009

Better Health Director receives Saltzman Award

Better Health Director Randall Cebul, MD, a MetroHealth internal medicine physician and
director of the Case Western Reserve University Center for Health Care Research and Policy
at MetroHealth, was presented with the Mt. Sinai Health Care Foundation’s prestigious
Maurice Saltzman Award for 2009. Dr. Cebul was recognized at the Foundation’s annual
meeting on June 15 for his efforts in establishing and leading Better Health Greater
Cleveland, a community-wide collaboration of those who get care, give care and pay for
care that is dedicated to improving the health and value of health care for people in
Northeast Ohio with chronic medical conditions.

The Hon.Dan A. Polster, chair of the award selection committee, said the award has
become one of the most prestigious honors in Cleveland, which made the selection
process both a privilege and a challenge. “As director of the Better Health Greater
Cleveland initiative, Dr. Cebul has brought together community-wide stakeholders from all
facets of the health care industry to address chronic illnesses in a manner never before
attempted,” said Polster. “Because of his leadership, Greater Cleveland now has the
infrastructure necessary to change the quality of care and reduce the economic and
personal burden of chronic disease. His uncompromising drive for high-quality care and
measurable outcomes has helped his colleagues move the needle toward better care and
better outcomes for 25,000 patients currently served by this initiative.”

Dr. Cebul said he was “tremendously honored and thankful to the Mt. Sinai Health Care
Foundation,” but the award was “not about me.” He said it was about themes that are
playing out nationally in the dialogue about health care reform, including improving access
to care for those who are disadvantaged, improving health outcomes and reducing costs of
care for those with chronic conditions, and about the intelligent use of health information
technology to monitor, coordinate and improve care. But mostly, he said, it was about
building effective partnerships of leaders in primary care across the region.
The award was established in 1983 to honor the late Maurice Saltzman, who was involved
in human service causes for more than 30 years and demonstrated a special interest in
health, medicine and collaboration.

January 27, 2009

Doctors, patients doing better at managing diabetes

Better Health Greater Cleveland, a health-quality group that began examining
Cleveland-area diabetes patients in 2007, says in its latest report that doctors and patients
are doing slightly better at managing the chronic disease. Read the full story.

June 18, 2008

Local project tackles diabetes complications

If you've been diagnosed with diabetes, you've got a better chance than the rest of us of
going blind, losing a leg, having a stroke. A group of health-care experts from around
Cleveland want to whittle away those complications. Read the full story.

June 12, 2008

Working together to cut the health care gap

Cleveland's diabetes rate is almost twice the state's rate and far higher than the
national rates. Health care providers are working with a national foundation to figure
out which best practices will narrow the gap, and close other health care inequities
nationwide. Read / listen.